Healthcare Provider Details

I. General information

NPI: 1154824431
Provider Name (Legal Business Name): LISA E LOEWENSTEIN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEMORIAL STADIUM DR
LINCOLN NE
68588-0031
US

IV. Provider business mailing address

501 W CARRINE DR
LINCOLN NE
68521-5336
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-2276
  • Fax:
Mailing address:
  • Phone: 402-540-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number356
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: